Helping People Deal with Emotional Trauma During and After Disasters

No one can forecast exactly when or where the next disaster on the scale of Hurricane Sandy will hit New Jersey. But it’s not hard to predict the psychological and emotional toll such a disaster will take on many state residents.
“What is not unpredictable…is that survivors, first responders, everyone impacted by the disaster event will experience a range of emotions and we have to respond to those emotional needs appropriately through crisis counseling,” observed state Human Services Commissioner Jennifer Velez.
Recent research findings heard by about 250 people attending a recent Rutgers University conference may help New Jersey responders and residents cope better with future disasters.

One aspect of research reviewed at the June 28 conference showed that people coping with disasters don’t necessarily fit traditional criteria for diagnosing mental illnesses. Some exhibit a range of life-disrupting symptoms, but the combined symptoms may not fit any single diagnosis, according to Fran H. Norris, one of three officials from the National Center for Posttraumatic Stress Disorder who attended the University Center for Disaster Preparedness and Emergency Response conference held on the Busch Campus in Piscataway.

While patients must show several specific symptoms to be diagnosed with diseases like PTSD or depression, she said, patients with one or two symptoms of a few different illnesses may still need counseling even if they haven’t been formally diagnosed with a specific illness.

“What we see is a little of this, a little of that and a little more of this” symptoms, said Norris, who also is director of the National Center for Disaster Mental Health Research. “An individual may not meet criteria for any one disorder but what you see is this constellation of ‘Just not feeling very well, thank you.’ ”

Norris added that after disasters, people frequently recognize various physical ailments, but won’t recognize the mental health issues that could be linked to some of those problems.

Researchers have also learned from studying the effects of previous disasters that there is individual trauma and collective trauma, and that how authorities respond to disasters can have far-reaching ramifications, conference attendees heard. For example, the response to the 1979 partial nuclear meltdown at Three Mile Island in Pennsylvania resulted in long-term emotional damage and stress even though no one was injured, Norris said.

Disasters present unique challenges to counselors, since the counselors’ own views and feelings are affected by the disasters, according to Jessica L. Hamblen, also from the National Center for Posttraumatic Stress Disorders.

This can be difficult for counselors who are treating people by using cognitive behavioral therapy – which is a form of counseling that aims to help patients recognize inaccurate or negative thinking so that they can handle challenges more clearly and effectively.

Since the counselors themselves might respond emotionally to a disaster – such as over-estimating the odds that another disaster will strike – they must work against this impulse when trying to help their patients think more clearly about their situations, Hamblen said.

“Sometimes those thoughts sound pretty darn accurate,” Hamblen said of patients’ fears. “We’re not saying there isn’t some truth to them, we’re just saying that the way in which they think these things isn’t always helpful.”

One piece of research that may reassure New Jersey responders is that the worst mental-health effects occur in the first year after the disaster. Norris said a notable exception was the recovery from Hurricane Katrina around New Orleans.

While the state is nearly four months from the first anniversary of Sandy, it recently arrived at another challenging landmark – the beginning, on June 1, of the first hurricane season since the storm.

Disaster counseling was a state priority before Sandy, allowing counselors to respond quickly in the storm’s aftermath, according to Adrienne Fessler Belli, director of the disaster and terrorism branch of the Division of Mental Health and Addiction Services.

State Health Commissioner Mary E. O’Dowd cited an additional challenge for some New Jersey residents affected by Sandy: Federal aid is targeted toward those whose primary residences were damaged or destroyed, so those who lost second homes face stresses that are difficult for behavioral-health responders to deal with effectively because those victims are scattered throughout the state.

“While so much of our focus is on these very impacted communities, those people live somewhere else,” O’Dowd noted.
Charles Figley of Tulane University described the complexities of “disaster resilience,” a set of traits that can aid in responding to disasters. He said responders can use residents’ resilience to their advantage, by recognizing those who are highly resilient and training them to help others.

“Trauma resilience is an important concept that’s an alternative to focusing on mental disorders” like PTSD and depression, Figley said. He said that PTSD diagnoses of residents are now used too frequently. “We have to have a way of focusing on functioning, of how they’re doing and then enabling them to function more effectively.”

By recognizing mental-health traumas caused by disasters, Figley said, counselors can help people before these “injuries” become mental-health disorders.

Norris added this encouraging note: “Posttraumatic stress is almost universal, (but) most people are going to get better” without being diagnosed with a disorder.